Ask a question on the site
Questions
Lawyers
Blogs
Legislation
Contacts
Become a lawyer
Login Registration
Subchapter I. Pharmacy Audit Integrity Program [For application of this subchapter, see 80 Del. Laws, c. 245, § 2]
§ 3301A. Pharmacy Audit Integrity Program [For application of this section, see 80 Del. Laws, c. 245, § 2]. - The Pharmacy Audit Integrity Program is established to provide standards...
§ 3302A. Definitions [For application of this section, see 80 Del. Laws, c. 245, § 2; and 83 Del. Laws, c. 256, § 15]. - For purposes of this subchapter: (1) “Entity” means a pharmacy...
§ 3303A. Pharmacy benefit manager contract [For application of this section, see 80 Del. Laws, c. 245, § 2]. - An amendment to pharmacy audit terms in a contract between...
§ 3304A. Procedure and process for conducting and reporting an audit [For application of this section, see 80 Del. Laws, c. 245, § 2]. - (a) Audit procedures. — Unless otherwise prohibited by federal requirements...
§ 3305A. Requirements for recoupment or chargeback [For application of this section, see 80 Del. Laws, c. 245, § 2]. - For recoupment or chargeback, the following criteria apply: (1) Audit...
§ 3306A. Documentation [For application of this section, see 80 Del. Laws, c. 245, § 2]. - (a) To validate the pharmacy record and delivery, the pharmacy...
§ 3307A. Appeals process [For application of this section, see 80 Del. Laws, c. 245, § 2]. - The entity conducting the audit must establish a written appeals...
§ 3308A. Audit information and reports [For application of this section, see 80 Del. Laws, c. 245, § 2]. - (a) A preliminary audit report must be delivered to the...
§ 3309A. Disclosures to plan sponsor [For application of this section, see 80 Del. Laws, c. 245, § 2]. - Where contractually required, an auditing entity must provide a copy...
§ 3310A. Applicability of other laws and regulations [For application of this section, see 80 Del. Laws, c. 245, § 2]. - This subchapter does not apply to any investigative audit that...
Subchapter II. Maximum Allowable Cost Pricing for Prescription Drugs and Reimbursement for and Provision of Pharmacy Goods or Services [For application of this subchapter, see 80 Del. Laws, c. 245, § 2; and 83 Del. Laws, c. 256, § 15]
§ 3321A. Definitions [For application of this section, see 80 Del. Laws, c. 245, § 2]. - As used in this subchapter: (1) “Claim” means a request...
§ 3322A. Exclusions [For application of this section, see 80 Del. Laws, c. 245, § 2]. - This subchapter does not apply to the Department of Health...
§ 3323A. Requirements for maximum allowable cost pricing [For application of this section, see 80 Del. Laws, c. 245, § 2; and 83 Del. Laws, c. 256, § 15]. - (a) To place a drug on a maximum allowable cost...
§ 3324A. Appeals [For application of this section, see 80 Del. Laws, c. 245, § 2; and 83 Del. Laws, c. 256, § 15]. - (a) A pharmacy benefits manager must establish a process by...
§ 3325A. Reimbursement for and provision of pharmacy goods or services For application of this section, see 83 Del. Laws, c. 256, § 15]. - (a) For purposes of this section: (1) “Affiliate” means a...
Subchapter III. Permitted Disclosures Related to Prescription Drugs [For application of this subchapter, see 81 Del. Laws, c. 378, § 2].
§ 3331A. Definitions [For application of this section, see 81 Del. Laws, c. 378, § 2; and 83 Del. Laws, c. 256, § 15]. - For purposes of this subchapter: (1) “Pharmacist” means as defined...
§ 3332A. Permitted disclosures related to prescription drugs [For application of this section, see 81 Del. Laws, c. 378, § 2; and 81 Del. Laws, c. 256, § 15]. - A contract between a pharmacy benefits manager and a pharmacy...
Subchapter IV. Prior Authorization of Emergency Prescriptions and Prescriptions for Chronic or Long-Term Conditions
§ 3335A. Definitions. - As used in this subchapter: (1) “Emergency” means a situation...
§ 3336A. Prior authorization of emergency prescriptions. - A pharmacy benefit manager may not require prior authorization for...
§ 3337A. Prior authorization of prescriptions for chronic or long-term conditions. - (a) A prior authorization form for a prescription medication shall...
Subchapter V. Registration of Pharmacy Benefits Managers
§ 3351A. Definitions [For application of this section, see 83 Del. Laws, c. 256, § 15]. - For purposes of this subchapter: (1) “Pharmacy benefits management services”...
§ 3352A. Applicability. - This subchapter does not apply to plans of health insurance...
§ 3353A. Registration required [For application of this section, see 83 Del. Laws, c. 256, § 15]. - (a) A pharmacy benefits manager shall register with the Commissioner...
§ 3354A. Expiration and renewal of registration [For application of this section, see 83 Del. Laws, c. 256. § 15]. - (a) A pharmacy benefits manager registration expires on May 1...
§ 3355A. Denial, suspension, or revocation of registration [For application of this section, see 83 Del. Laws, c. 256, § 15]. - (a) The Commissioner may deny a registration to a pharmacy...
§ 3356A. Recordkeeping requirements. - A pharmacy benefits manager shall maintain adequate books and records...
§ 3357A. Examination of affairs, transactions, accounts, and records. - (a) Whenever the Commissioner considers it advisable, the Commissioner may...
§ 3358A. Permit required for nonresident pharmacy to deliver prescription drugs or devices. - A pharmacy benefits manager may not ship, mail, or deliver...
Subchapter VI. Pharmacy Benefits Manager Network Requirements [For application of this subchapter, see 83 Del. Laws, c. 256, §? 15]
§ 3361A. Definitions [For application of this section, see 83 Del. Laws, c. 256, § 15]. - For purposes of this subchapter: (1) “Claim” means as defined...
§ 3362A. Pharmacy benefits manager network [For application of this section, see 83 Del. Laws, c. 256, § 15]. - (a) A pharmacy benefits manager shall provide a reasonably adequate...
§ 3363A. Reports [For application of this section, see 83 Del. Laws, c. 256, § 15]. - (a) A pharmacy benefits manager shall provide a pharmacy benefits...
Subchapter VII. Prohibited Practices; Penalties; Enforcement [For application of this subchapter, see 83 Del. Laws, c. 256, §? 15]
§ 3371A. Definitions [For application of this section, see 83 Del. Laws, c. 256, § 15]. - For purposes of this subchapter: (1) “Board of Pharmacy” means...
§ 3372A. Prohibited practices [For application of this section, see 83 Del. Laws, c. 256, § 15]. - A pharmacy benefits manager or representative of a pharmacy benefits...
§ 3373A. Penalties and enforcement [For application of this section, see 83 Del. Laws, c. 256, § 15]. - (a) If the Commissioner determines that a pharmacy benefits manager...